17 March 2014
Associate Professor Anthony Lowe, CEO, Prostate Cancer Foundation of Australia
Alison Amos, CEO, Ovarian Cancer Australia
Incredible scientific advances since the mapping of the human genome a decade ago have led to a fundamental shift in our understanding of cancer.
We now know that many common cancers, such as breast and ovarian, are made up of a number of distinct sub types. Each of these is characterised by a different molecular signature, which drives its growth and resistance to treatment in different ways.
No two people have exactly the same type of tumour – even if it's located in the same organ. One person's cancer of the ovary may have more in common with another's kidney cancer than someone else's ovarian cancer.
We no longer think of cancer as one disease. It is hundreds.
This understanding opens exciting possibilities for medical research. We're moving towards a world in which 'personalised medicine' will one day mean each patient's tumour is genetically profiled so doctors can understand its unique signature.
Combinations of drugs will then be tailored to combat the individual's cancer – offering a much better chance of successful treatment than the broad brush approach of today.
Already the collective efforts of cancer researchers are bearing fruit. Take for example our understanding of the role of a mutation in the BRCA gene, made famous recently by actor Angelina Jolie's brave decision to have a series of surgeries to prevent breast and ovarian cancer.
This same mutation, particularly in the BRCA2 gene, is also responsible for an increased risk of prostate cancer. It means that in future we may advise men carrying the gene that they might want to consider regular testing from a younger age than those without.
The BRCA gene was discovered as a result of work into women’s predisposition to breast cancer, but the findings have extended far beyond that disease.
Treatments, too, can have applications beyond the cancers of individual organs by treating commonalities across different cancer sub types. For example, immunotherapy drugs offering new hope to melanoma patients are now showing promise in the most deadly of cancers, lung cancer.
That is not to say that people with cancers of certain organs do not need specialised support. They do.
People suffering the life-changing side effects of treatment for prostate cancer are in great need of resources to help them make informed treatment decisions, for example. In the case of ovarian cancer, women in high risk families need to be supported and informed through the difficult but promising process of risk reduction. Molecular sub-typing at initial diagnosis and recurrence is crucial to improving the poor survival rates currently experienced by women.
However, for the many organisations that advocate for people affected by cancer, it has become more of a collective battle than an individual one.
Jane Cadzow, in her recent article entitled Cancer Wars (SMH, March 8, 2014), suggests that the success of larger organisations such as the National Breast Cancer Foundation and the Prostate Cancer Foundation of Australia in attracting funding somehow detracts from the ability of other bodies to do their work.
This misses the point.
What we need more than ever is a collective effort towards our common goal to overcome cancer as the world's largest killer.
It's a fact recognised globally, where the trend is for research organisations to share resources and information, for example by banking thousands of tumour samples for genetic analysis by different groups around the world.
But making any progress in cancer research is extraordinarily expensive. For national cancer bodies like us, it's not a question of who has the largest share of the funds – it's a question of boosting the size of the overall pot and using resources strategically to improve the outlook for the men and women with cancer we serve.
We welcome the success of the breast cancer "crusade" in raising awareness, attracting funding and advancing our understanding of cancer. It is benefitting us all.